Cultures of Life, Death and Suicide

Rob Marris MP has brought the 'Assisted Dying' Bill as a Private Members Bill before the House of Commons. This Bill had earlier been proposed by Lord Falconer in the House of Lords but ran out of time during the last Parliament. The vote on this Bill is to take place on Friday 11 September 2015. The following are some reasons for encouraging our MPs to vote against the Bill. The Church of England's official briefing (toward the end of this paper) is from the Coloured Supplement for October 2009. It is worthy of republication and rereading.

Jesus and the culture of life

Not only is our God to be identified with love but also with life. So Jesus, the Divine Son, says: "as the Father has life in himself, so he has granted the Son also to have life in himself" (John 5.26). And Jesus says a little later on in John,

"I am the resurrection and the life. Whoever believes in me, though he die, yet shall he live, and everyone who lives and believes in me shall never die" (John 11.25-26).

That wonderful fact that Jesus Christ embodies life is behind his great mission on earth to defeat death through conquering sin. And Paul underlines that correlation between Christ and life when he says …

"… as by man came death, by a man has come also the resurrection of the dead. For as in Adam all die, so also in Christ shall all be made alive" (1 Corinthians 15.21-22).

And Paul can end that great chapter 15 like this:

"'Death is swallowed up in victory. O death, where is your victory. O death, where is your sting?' The sting of death is sin, and the power of sin is the law. But thanks be to God, who gives us the victory through our Lord Jesus Christ" (1 Corinthians 15.51-57).

So not only at Easter time but throughout the year, and particularly this month, we need to focus on the fact that life is of the essence of our God and that Jesus, through his Resurrection, proves that life is of his essence also. For as never before in the West we are having to fight what has been called "a culture of death".

Over the summer of 2015, on the one hand, there have been brutal murders from Islamic religious extremists - the most publicized being on a beach in Sousse, Tunisia. Now, on the other hand, from the opposite secular extreme, there is a different form of the culture of death. It is less publicized, more subtle and evokes, understandably, much sympathy: but it is hugely significant. It is through the promotion of assisted suicide and in the form of the "Assisted Dying" Bill that is to be voted on this month.

The new culture of death

This new culture of death came in during the 1960s and was the result of legal innovations and media initiatives that promoted death through seeking to give the green light to abortions and euthanasia. It plausibly can be argued that it began with the decriminalizing of suicide and so the Suicide Act of 1961. That was achieved by claiming there needed to be a separation of the law from morality. Sadly, many failed to see that such separation of the law from morality meant a separation from Christian morality; and the result would not be neutrality, but the law now joined to a new pagan morality. An able Oxford Law Professor, who promoted the new legislation, was H L A Hart. He began his little 1963 book, Law, Liberty and Morality, with these words:

"The Suicide Act 1961, though it may directly affect the lives of few people, is something of a landmark in our legal history. It is the first Act of Parliament for at least a century to remove altogether the penalties of the criminal law from a practice both clearly condemned by conventional Christian morality and punishable by law. Many hope that the Suicide Act may be followed by further measures of reform and that certain forms of abortion, homosexual behaviour between consenting adults in private, and certain forms of euthanasia will cease to be criminal offences."

Of course, suicide is always terribly tragic, always with so many factors involved, always many people affected and always needing compassion and understanding. Hart, however, was not right. The Suicide Act of 1961 still recognized the Christian moral tradition that says suicide is always morally wrong (and that is because of the Sixth Commandment against murder, which includes self-murder and is something not only Christians understand, but also others of good will). The 1961 Act, of course, presupposes that moral tradition in prohibiting assistance for suicides. So it says in section 2(1):

"a person who aids, abets, counsels or procures the suicide of another, or an attempt by another to commit suicide, shall be liable on conviction on indictment to imprisonment for a term not exceeding fourteen years."

The awful reality

It is this 1961 offence of "complicity in suicide" some are working to repeal. They want the Government to introduce new legislation making assisted suicide legal. Prior to the recent General Election a letter with 80 signatories appeared to this effect in The Daily Telegraph at the end of December 2014. Among the reasons for allowing assisted suicide was the fact that "currently one Briton a fortnight ends their life in the Dignitas clinic in Switzerland" and that "no one believes that someone should face a prison sentence of 14 years for compassionately assisting a loved one to die."

What the letter did not say was that the only person to have had a serious conviction in recent years was for supplying a person with petrol and a lighter that resulted not in death but in horrific burns. The lack of compassion was the cause of the sentence. Nor did the letter mention the impossible reality placed on NHS doctors if assisted suicide becomes law. Fermand Melgar's 2005 documentary film Exit: Le Droit de Mourir (Exit: the Right to Die) shows the reality for volunteer Swiss suicide "escorts". The leader of the group admits the work is emotionally exhausting, "we have to rest between two missions, recharge our batteries; this is not something you can do as regularly as clockwork … It is an exceptional act, every single time. I am exhausted after every assisted suicide." So says someone committed to killing. How wicked to expect UK medical professionals, committed to saving lives, to kill like these "escorts".

Since that December 2014 letter the debate regarding suicide has widened following what happened at the end of March 2015. That was when Andreas Lubitz, a suicidal co-pilot, locked his captain out of the cockpit of their airliner and flew 149 people into a mountainside in the French Alps at 500 mph killing everyone. The question that can be asked is, "how much the undermining of the Christian moral tradition in Western Europe, namely that suicide is always wrong, affects suicidal thoughts and so suicides?"

Knowing what others think and do about suicide affects the suicidal. For there is a "social contagion" aspect to suicide leading to copycat suicides. Notoriously in 1933 on the Japanese island of Izu Oshima, a 21 year-old female student, Kiyoko Matsumoyo, jumped into the volcano of Mount Mihara from an observation point. Overnight she became a celebrity and 944 people (804 men, 140 women) jumped like she had done into the volcano's crater in 1933 alone.

The basic biblical perspective over the taking of life is clear. God is our creator. Human life is not our 'property' - it is held in trust or on loan from him. We may not, therefore, just 'dispose' of it. As Job said: "The Lord gave and the Lord has taken away" (Job 1.21). Also, as already noted, there is that fundamental prohibition on killing in the Ten Commandments (Ex 20.13). Its basis for it is set out in Genesis 9.6: "Whoever sheds the blood of man, by man shall his blood be shed; for God made man in his own image." Our significance, human dignity and so our claim to protection derives, therefore, not from our "quality of life" or gifts and abilities, but from our status as being made in God's image. So suicide soon came to be seen as wrong in the Church. In the early church Augustine said it was like murdering yourself, so contravening the sixth commandment against murder. In the 16th century one of the Reformed Catechisms similarly said: "the sins forbidden in the sixth commandment" include "all taking away the life of ourselves." But views have varied over culpability. Certainly that ethic, being institutionalized in law, has had practical benefit.

Aaron Kheriaty

In his recent paper, Apostolate of Death, Aaron Kheriaty, a Professor of Psychiatry at the University of California, Irvine School of Medicine, argues that, if assisted suicide is permitted, in time it will not be restricted to terminal illness. In Belgium, assisted suicide has been granted to a woman with "untreatable depression". In Holland, where also there is assisted suicide, not wanting to live in a nursing home qualifies for assistance! So, he asks, why not the "merely unhappy, demoralized, dejected, depressed or desperate. If assisted suicide is good, why limit it only to a select few?" (by the way, the only other European countries with assisted suicide are Switzerland and Luxembourg – it is not common in Europe). Kheriaty points out, too, that

"… suicidal individuals typically do not want to die; they want to escape what they perceive as intolerable suffering. When comfort or relief is offered, in the form of more adequate treatment for depression, better pain management, or more-comprehensive palliative care, the desire for suicide wanes. We know that the vast majority of suicides are associated with clinical depression or other treatable mental disorders; yet alarmingly, less than 6 percent of the 752 reported cases of individuals who have died by assisted suicide under Oregon's law were referred for psychiatric evaluation prior to their death. This constitutes gross medical negligence."

Kheriarty also writes about the "social contagion" aspect to suicide in the United States. This seems to be happening in Oregon (one of the few States to have assisted suicide). For following the legalization of physician-assisted suicide in 1997, the 1990s decline in suicide rates was reversed such that there was a significant increase between 2000 and 2010 with the rates now 35% higher than the national average. He also mentions the suicide "hot spot" – the Golden Gate Bridge in San Francisco …

"… where fourteen hundred people have died, while only a handful have survived the jump. A journalist tracked down a few of these survivors and asked them what was going through their minds in the four seconds between jumping off the bridge and hitting the water. All of them responded that they regretted the decision to jump, with one saying, 'I instantly realized that everything in my life that I'd thought was unfixable was totally fixable - except for having just jumped.' This small sample is consistent with larger studies of suicide survivors. Ten years after attempted suicide, nearly all survivors no longer wish to die but are pleased to be alive. To abandon suicidal individuals in the midst of a crisis—under the guise of respecting their autonomy—is socially irresponsible: it undermines sound medical ethics and erodes social solidarity."

Kheriarty is clear: "Refusing to legitimate suicide helps those in need. The practice of physician-assisted suicide – by whatever name one calls it – sends a message that some lives are not worth living. The law is a teacher: if assisted suicide is legalized, this message will be heard by everyone who is afflicted by suicidal thoughts or tendencies."

"Assisted Dying/Suicide and Voluntary Euthanasia" – a briefing

The following is a Church of England statement on assisted dying/suicide issued prior to a previous Parliamentary debate.

"While acknowledging the complexity of the issues involved in assisted dying/suicide and voluntary euthanasia, the Church of England is opposed to any change in the law or in medical practice that would make assisted dying/suicide or voluntary euthanasia permissible in law or acceptable in practice. The Church also acknowledges that those who seek a change in the law are often motivated by compassion and by a desire to see individuals treated with dignity and respect - motives that the Church also upholds. Equally, the Church shares the desire to alleviate physical and psychological suffering, but believes that assisted dying/suicide and voluntary euthanasia are not acceptable means of achieving these laudable goals.

At the heart of this debate is the relationship between two important principles:personal autonomy and the protection of life. Often these principles are complementary but, at times, they compete for priority. The Church believes that personal autonomy has an invaluable role to play in a civilized society but autonomy ought not to be understood or exercised without regard to others. Autonomy ought to be 'principled autonomy'. Our actions affect others both directly and indirectly and this reality ought to place boundaries on unbridled autonomy. In truly extreme cases, protection of life is sometimes impossible to achieve. This does not, however, undermine the importance of this principle or necessitate a change in the law. For Christians, the innate dignity and value of human beings comes from the belief that we are made in the image of God. It is not, of course, necessary to share this religious conviction to agree that every human being is uniquely and equally valuable. Without such a belief, society would degenerate into moral disorder with a social misapplication of 'survival of the fittest' replacing allegiance to our common humanity. Human Rights are built on the foundation of the 'right to life' as is much of the criminal code. Compassionate reactions to natural disasters and to the victims of war stem from a belief in the value of life. There ought always to be a 'presumption in favour of life' and where personal autonomy and protection of life conflict, protection of life ought to be given priority. Society and its agents ought to act to protect life and only where this is truly not tenable, such as in a situation of extreme violence or danger, ought this principle to be breached.

In assisted dying/suicide and voluntary euthanasia individuals seek the right to dictate how they may die, requiring doctors and nurses, as the agents of society, either to take life or to assist in the taking of life. Where a right is given, a corresponding obligation to respect, protect and to promote that right must also be acknowledged. A right for one must be a right for all and a right for all can only be upheld by society ensuring that every person has access to that right. An obligation on society and its agents to take life or to assist in the taking of life, by ensuring a universal right to assisted dying/suicide or to voluntary euthanasia, would create a new and unwelcome role for society.

Problems in practice

There are problems ensuring that any law permitting assisted dying/suicide or voluntary euthanasia could be sufficiently safe-guarded against abuse. Evidence from jurisdictions that allow assisted dying/suicide or voluntary euthanasia suggests that there have, indeed, been problems of ensuring that due process is always carried out and that adequate support services are always in place. As well as there being concerns that one change in the law will lead to further, greater, changes there is an inevitability that any law, however tightly formulated, will be interpreted variously by different people. A reference to 'severe suffering', for example, can only be interpreted subjectively while an estimate of how long a terminally ill person may have to live can only be precisely that - an estimate. Inevitably, doctors will vary in their approach and consistency will be impossible to achieve, with 'wider' interpretations of the law becoming acceptable.

Even with safeguards of mandatory counselling and 'cooling off periods' it is impossible to ensure that vulnerable, terminally ill patients, especially elderly patients without close family support, will not feel under moral, economic or social pressure to accept assisted dying/suicide or voluntary euthanasia. What may appear as greater freedom of choice for some can easily become a greater source of pressure for others. One such person is one too many and would represent an affront to them, to health professionals and to society.

It has been a source of comfort and assurance to millions of people that the NHS has provided care and protection as well as life-enhancing and life-saving interventions since its inception over sixty years ago. Trust in the health service is crucial to the health and well-being of individuals and of the population. To introduce assisted dying/suicide or voluntary euthanasia into the NHS (for only in this way could the 'right' be made universally accessible) would be to change fundamentally the nature of the NHS. The effects of this are likely to be far-reaching, particularly if assisted dying/suicide or voluntary euthanasia were to be perceived as being a 'cost-effective' way of dealing with terminal illness. Also the nature of the doctor and nurse/patient relationship would change fundamentally and irrevocably, if assisted dying/suicide or voluntary euthanasia were to become part of the 'treatment' that health professionals were to be able to offer their patients. Trust between doctor/nurse and patient is not always easily achieved; any change in medical or nursing practice in the area of care of the terminally ill is likely to have an adverse effect on such relationships. A 'conscience clause' allowing doctors and nurses to 'opt out' of assisted dying/suicide or voluntary euthanasia would often mean that patients would be introduced to new staff unknown to them at a most vulnerable stage in their lives, undermining patient care

Conclusion and the effects on Palliative Care

Making assisted dying/suicide or voluntary euthanasia 'workable' would require large resources, employing medical, nursing, counselling, legal and social-work staff with accompanying additional training and resources. With all of this, there is still no guarantee that assisted dying/suicide or voluntary euthanasia would be safely and fairly administered. In the mean-time, medical palliative care, which has been shown to be highly effective is still not uniformly available throughout the country. The additional psychological, social, family and (where requested) spiritual support services needed to address all of the needs of terminally ill people in a full palliative 'care-package,' are equally under-resourced. What is required is a commitment to making effective support a reality for all terminally ill patients. Suffering may be met with compassion, commitment to high-quality services and effective medication. Meeting it by assisted dying/suicide or through voluntary euthanasia, however well intentioned, is merely removing it in the crudest way possible."